Modern medicine is seeing the rising power of the pharmaceutical companies.

Over the past 60 years, medicine has metamorphosed from a modest pursuit of limited effectiveness to a massive global phenomenon employing millions and costing trillions.

Now, in the vast shiny palace that the modern hospital has become, the previously unimaginable goals of transplanting hearts or curing certain cancers are commonplace, while, every year, legions of those doomed to blindness from cataracts or crippling arthritis have their sight and mobility restored.

And yet the more powerful the medical enterprise has become, the greater the incentive for its professional and commercial interests to extend their influence yet further – resulting in the progressive “medicalisation” of people’s lives to no good purpose. Its many forms are familiar enough, from the over-investigation and over-treatment of minor complaints, anxiety-mongering about trivial or non-existent threats to health and the propagation of unrealistic expectations of the latest “breakthrough”.

These trends are scarcely novel but have become more pervasive as health service expenditure has doubled and doubled again, soaring by an astonishing £60 (£37) billion a year in the past decade alone. The need to curtail the harmful consequences of medicalisation may seem daunting but, looking back over the past 10 years at the relative contribution of the two driving forces in medicine – technical innovation and the pharmaceutical industry – is instructive.

The main factor behind those spiralling health-care costs is volume. Doctors are doing vastly more than in the past, extending the benefits of medical interventions to the ever-growing ageing population.

Thus, much of the surgery involved in, say, re-plumbing damaged arteries or replacing arthritic hips is a form of applied engineering, constrained only by the vulnerability of the tissues and organs to the trauma of the procedures involved. Make those procedures simpler and less traumatic, then the numbers eligible will rise dramatically.

The possibilities are well illustrated by the treatment options for the tens of thousands whose severe angina is not controlled by medication. This condition, like so many, is age-determined, increasing in prevalence with each passing decade. But the standard, three-hour-plus bypass operation, with all its requirements for splitting the chest and harvesting veins from the legs, is far too onerous for (relatively) old and frail patients to contemplate.

Not so the coronary angioplasty, devised by Andreas Gruentzig, a German cardiologist, that restores the blood flow to the heart muscle by dilating the narrow arteries “like a footprint in the snow” with a balloon-tipped catheter. No surprise, then, to learn that, over the past 10 years, the number of those aged 80 or over to have benefited from a coronary angioplasty has increased twelvefold.

It is a similar story on a yet greater scale for keyhole or minimally invasive surgery – the single most radical development since the introduction of anaesthesia in the mid-19th century. The appeal of these sophisticated, if technically very demanding, procedures for the elderly and those disabled by chronic illnesses is obvious enough. Still, its ascendancy in the recent past now embraces the entire range of surgical specialities: the number of arthroscopies for damaged or arthritic joints having leapt eightfold, while similar operations on the bladder have risen from 123,000 to 289,000.

The singular achievement of these technical innovations has been to transform so many of the physical ailments of later life from the inevitable consequence of a natural ageing process into specific problems for which medical intervention is appropriate.

The contribution of the pharmaceutical industry to the medical expansionism of the past decade would seem to run in parallel. Here, doctors are not just doing more, but prescribing (vastly) more – an additional 300 million prescriptions a year, half as many again compared to just 10 years ago. It is now not unusual for people to be “on” half a dozen or more different types of medication, with this polypharmacy, as it is known, predictably being commoner in the older age groups – though its value is much harder to quantify than those technical innovations.

The merits of a coronary angioplasty in promptly relieving the crippling chest pains of angina is self-evident, but the rationale for the majority of those 300 million extra prescriptions is very different – being primarily intended to reduce the risk of some medical misfortune, such as a stroke or heart attack, in the future.

This approach has ensured the continuing profitability of the pharmaceutical industry, whose annual revenues worldwide have escalated in the past decade from $400 (£250) billion to $800 (£500) billion. But, alleges Dr Marcia Angell, the former chief editor of the New England Journal of Medicine, the pharmaceutical industry has, in the process, “moved very far from the original high purpose of discovering and producing useful new drugs. Now primarily marketing machines to sell drugs of dubious benefit, it uses its wealth and power to co-opt every institution that might stand in its way – including the medical profession itself.”

Dr Angell’s observations require some elaboration. Surprising though it might seem, the pharmaceutical industry was in the doldrums back in the early Eighties, as the cornucopia of drugs that had tumbled out of its research laboratories over the previous three decades – antibiotics, steroids, drugs for the treatment of depression, arthritis, cancer, diabetes, etc – had slowed to a trickle.

There was, noted an editorial in the journal Nature, “a dearth of new drugs” with only a small proportion offering “even modest therapeutic gain”. None the less, the next few years would witness the rise of the “blockbuster” drug, with annual sales in excess of $1 billion (£627 million). The first, the acid suppressant Zantac arrived in 1984; by 1990, there were a further five; 10 years later, that number had risen to 29; and by last year there were more than 100, 20 of which generate up to six times the revenue of Zantac in its heyday.

The ramifications of this astonishing transformation of the pharmaceutical industry’s fortunes are certainly complex, but the guiding principle, as Dr Angell suggests, has been the deployment of sophisticated marketing techniques to create a demand for their drugs.

These include recruiting prominent positions (or KOLs, Key Opinion Leaders, as they are known in the business) to redefine and expand the major categories of illness; subsidising “independent” patient support groups; financing the clinical trials for evaluating their drugs; publicising their (invariably favourable) findings; and influencing the deliberations of those expert committees whose guidelines defining ever lower “normal” levels for such variables, such as blood pressure and cholesterol, generate incremental leaps in the numbers warranting treatment.

Thus, three million people in Britain now take the cholesterol-lowering statins that, worldwide, yield an average $29 (£18) billion a year – and whose many adverse side-effects, particularly in the elderly, have, until recently, been concealed.

This, then, is the Janus face of modern medicine, the most visible symbol of the power of science to banish disease for the benefit of all. But the distinction between the relative contributions of those technical innovations and the pharmaceutical industry to the spiralling costs of health care reveals, with great clarity, the origins and harmful consequences of medicalisation – and what indeed is required to control it.

A revised and updated version of James Le Fanu’s 'The Rise and Fall of Modern Medicine’ is available from Telegraph Books for £14.99 plus £1.25 p&p. Call 0844 871 1515 or visit books.telegraph.co.uk